Stories of change in nutrition in Burkina Faso 1992–2018: a micro-level perspective
Tóm tắt
Looking back at what has effectively improved nutrition may inform policy makers on how to accelerate progress to end all forms of malnutrition by 2030. As under-five stunting declined substantially in Burkina Faso, we analyzed its nutrition story at the micro-level. We conducted a regression-decomposition analysis to identify demographic and health drivers associated with change in height-for-age using longitudinal, secondary, nationally-representative data. We triangulated results with findings from semi-structured community interviews (n = 91) in two “model communities” with a history of large stunting reduction. We found that improvement in immunization coverage, assets accumulation and reduction in open defecation were associated with 23%, 10% and 6.1% of the improvement in height-for-age, respectively. Associations were also found with other education, family planning, health and WASH indicators. Model communities acknowledged progress in the coverage and quality of nutrition-specific and nutrition-sensitive sectoral programs co-located at the community level, especially those delivered through the health and food security sectors, though delivery challenges remained in a context of systemic poverty and persistent food insecurity. Burkina Faso’s health sector’s success in improving coverage of nutrition and healthcare programs may have contributed to improvements in child nutrition alongside other programmatic improvements in the food security, WASH and education sectors. Burkina Faso should continue to operationalize sectoral nutrition-sensitive policies into higher-quality programs at scale, building on its success stories such as vaccination. Community leverage gaps and data gaps need to be filled urgently to pressure for and monitor high coverage, quality delivery, and nutrition impact of agriculture, education, and WASH interventions.
Tài liệu tham khảo
Alderman, H., & Headey, D. D. (2017). How Important is Parental Education for Child Nutrition? World Development, 94, 448–464. https://doi.org/10.1016/J.WORLDDEV.2017.02.007
Bailey, H. (2015). Stories of Change. Brighton: IDS.
Becquey, E., Birba, O., Golan, J., Le Port, A., Olney, D., Rawat, R., & van den Bold, M. (2014). Creating Homestead Agriculture for Nutrition and Gender Equity (CHANGE) program in Burkina Faso: Baseline Report. Helen Keller International.
Bhutta, Z. A., Das, J. K., Rizvi, A., Gaffey, M. F., Walker, N., Horton, S., et al. (2013). Evidence-based interventions for improvement of maternal and child nutrition: What can be done and at what cost? The Lancet, 382(9890), 452–477.
Bhutta, Z., Ahmed, T., Black, R., Cousens, S., Dewey, K., Giugliani, E., et al. (2008). What works? Interventions for maternal and child undernutrition and survival. Lancet, 371(9610), 417–440. https://doi.org/10.1016/S0140-6736(07)61693-6
Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., de Onis, M., Ezzati, M., Grantham-McGregor, S., Katz, J., Martorell, R., & Uauy, R. (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 382(9890), 427–451. https://doi.org/10.1016/S0140-6736(13)60937-X
Bliznashka, L., Arsenault, J. E., Becquey, E., Ruel, M. T., & Olney, D. K. (2020). Using structural equation modelling to understand the contributors to anaemia among young Burkinabe children. Maternal and Child Nutrition, 16(1), 1–13. https://doi.org/10.1111/mcn.12881
Burkina Faso. (2017a). Politique nationale Santé 2017-2026. Ouagadougou: Burkina Faso.
Burkina Faso. (2017b). Plan stratégique multisectoriel de nutrition 2017-2020. Ouagadougou: Burkina Faso.
Burkina Faso. (2018). Enquête nutritionnelle nationale. Ouagadougou: Burkina Faso.
Burkina Faso Ministère de la Santé. (2020). Plan stratégique multisectoriel de nutrition 2020–2024. Public Service of the Administration.
Clasen, T. F., Alexander, K. T., Sinclair, D., Boisson, S., Peletz, R., Chang, H. H., et al. (2015). Interventions to improve water quality for preventing diarrhoea. The Cochrane database of systematic reviews, 10, CD004794. https://doi.org/10.1002/14651858.CD004794.pub3
Cronin, A. A., Gnilo, M. E., Odagiri, M., & Wijesekera, S. (2017). Equity implications for sanitation from recent health and nutrition evidence. International Journal for Equity in Health, 16(1), 211. https://doi.org/10.1186/s12939-017-0709-5
Dangour, A. D., Watson, L., Cumming, O., Boisson, S., Che, Y., Velleman, Y., et al. (2013). Interventions to improve water quality and supply sanitation and hygiene practices and their effects on the nutritional status of children. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD009382.pub2
Doudou, M. H., Ouedraogo, O., Ouaro, B., Bidault, N., & Reinhardt, K. (2018). Mapping Nutrition Interventions, a Key Analytical Tool for Informing the Multisectoral Planning Process: Example From Burkina Faso. Food and Nutrition Bulletin, 39(3), 449–464. https://doi.org/10.1177/0379572118782881
Gillespie, S., Haddad, L., Mannar, V., Menon, P., & Nisbett, N. (2013). The politics of reducing malnutrition: Building commitment and accelerating progress. The Lancet, 382, 552–569. https://doi.org/10.1016/S0140-6736(13)60842-9
Gillespie, S., Hodge, J., Yosef, S., & Pandya-Lorch, R. (2016). Nourishing Millions: Stories of Change in Nutrition. International Food Policy Research Institute.
Gillespie, S., & van den Bold, M. (2017). Stories of Change in nutrition: An overview. Global Food Security, 13, 1–11. https://doi.org/10.1016/j.gfs.2017.02.004.
Headey, D., Hoddinott, J., & Park, S. (2017). Accounting for nutritional changes in six success stories: A regression-decomposition approach. Global Food Security, 13, 12–20. https://doi.org/10.1016/j.gfs.2017.02.003
Heckert, J., Olney, D. K., & Ruel, M. T. (2019). Is women’s empowerment a pathway to improving child nutrition outcomes in a nutrition-sensitive agriculture program?: Evidence from a randomized controlled trial in Burkina Faso. Social Science and Medicine, 233, 93–102. https://doi.org/10.1016/j.socscimed.2019.05.016
Institut National de la Statistique et de la Démographie. (1994). Enquête Démographique et de Santé Burkina Faso 1993. Ouagadougou, Burkina Faso and Calverton, Maryland, USA.
Institut National de la Statistique et de la Démographie. (2000). Enquête Démographique et de Santé Burkina Faso 1998-1999. Ouagadougou, Burkina Faso and Calverton, Maryland, USA.
Institut National de la Statistique et de la Démographie. (2004). Enquête Démographique et de Santé Burkina Faso 2003. ORC Macro.
Institut National de la Statistique et de la Démographie. (2012). Enquête Démographique et de Santé et à Indicateurs Multiples (EDSBF-MICS IV) Burkina Faso 2010. Ouagadougou, Burkina Faso and Calverton, Maryland, USA.
Institut National de la Statistique et de la Démographie -INSD, Programme d’Appui au Développement Sanitaire - PADS, Programme National de Lutte contre le Paludisme - PNLP, & ICF. (2018). Enquête sur les indicateurs du paludisme au Burkina Faso, 2017-2018. Rockville, Maryland, USA.
Institut National de la Statistique et de la Démographie -INSD, Programme National de Lutte contre le Paludisme -PNLP, & ICF International. (2015). Burkina Faso Enquête sur les Indicateurs du Paludisme (EIPBF) 2014. Rockville, Maryland, USA.
Institut Supérieur des Sciences de la Population. (2018). PMA2020/Burkina Faso Family planning brief November 2017 - January 2018 (Round 5). https://www.pmadata.org/sites/default/files/data_product_results/PMA2020-Burkina-R5-FP-Brief-EN.pdf. Accessed 24 February 2022.
Keats, E. C., Das, J. K., Salam, R. A., Lassi, Z. S., Imdad, A., Black, R. E., & Bhutta, Z. A. (2021). Effective interventions to address maternal and child malnutrition: An update of the evidence. The Lancet Child & Adolescent Health, 5(5), 367–384. https://doi.org/10.1016/S2352-4642(20)30274-1
Ngure, F., Gelli, A., Becquey, E., Ganaba, R., Headey, D., Huybregts, L., et al. (2019). Exposure to Livestock Feces and Water Quality, Sanitation, and Hygiene (WASH) Conditions among Caregivers and Young Children: Formative Research in Rural Burkina Faso. The American Journal of Tropical Medicine and Hygiene, 100, 998. https://doi.org/10.4269/ajtmh.18-0333
Pickering, A. J., Djebbari, H., Lopez, C., Coulibaly, M., & Alzua, M. L. (2015). Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: A cluster-randomised controlled trial. The Lancet Global Health, 3(11), e701–e711. https://doi.org/10.1016/S2214-109X(15)00144-8
Ruel, M. T., & Alderman, H. (2013). Nutrition-sensitive interventions and programmes: How can they help to accelerate progress in improving maternal and child nutrition? Lancet, 382(9891), 536–551. https://doi.org/10.1016/S0140-6736(13)60843-0
Ruel, M. T., Quisumbing, A. R., & Balagamwala, M. (2018). Nutrition-sensitive agriculture: What have we learned so far? Global Food Security, 17, 128–153. https://doi.org/10.1016/J.GFS.2018.01.002
Transform Nutrition West Africa. (2019). Country data profile - Burkina Faso. Washington, DC.
Turowska, Z., Buttarelli, E., Sombié, I., Nisbett, N., Van Den Bold, M., & Becquey, E. (2022). Stories of change in nutrition in Burkina Faso 1992-2018: A macro-level perspective. Food Security, forthcoming.
United Nations. (2015). Transforming our World: The 2030 Agenda for Sustainable Development. https://stg-wedocs.unep.org/bitstream/handle/20.500.11822/11125/unepswiosm1inf7sdg.pdf?sequence=1. Accessed 24 February 2022.
WHO, & UNICEF. (2017). Burkina Faso: WHO and UNICEF estimates of immunization coverage: 2016 revision. Geneva and New York. https://data.unicef.org/wp-content/uploads/country_profiles/BurkinaFaso/immunization_country_profiles/immunization_bfa.pdf. Accessed 19 March 2019.
World Health Organization. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. Geneva. https://www.who.int/publications/i/item/9789241549912. Accessed 24 February 2022.
Zombré, D., Allegri, M. D., Platt, R. W., Ridde, V., & Zinszer, K. (2019). An Evaluation of Healthcare Use and Child Morbidity 4 Years After User Fee Removal in Rural Burkina Faso. Maternal and Child Health Journal, 23(6), 777. https://doi.org/10.1007/S10995-018-02694-0